Provider Demographics
NPI:1831553452
Name:CORVALLIS BIRTH AND WOMENS HEALTH CENTER
Entity type:Organization
Organization Name:CORVALLIS BIRTH AND WOMENS HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JOY WEGELT
Authorized Official - Last Name:HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:541-286-4030
Mailing Address - Street 1:2314 NW KINGS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3925
Mailing Address - Country:US
Mailing Address - Phone:541-286-4030
Mailing Address - Fax:541-286-4158
Practice Address - Street 1:2314 NW KINGS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3925
Practice Address - Country:US
Practice Address - Phone:541-286-4030
Practice Address - Fax:541-286-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing